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PubMed2000

Employer-sponsored long-term care insurance: best practices for increasing sponsorship.

Behind the enthusiasm of policymakers for long-term care (LTC) insurance is the belief that increased ownership of private LTC insurance will reduce the government's future liability for financing the nation's LTC needs, currently projected by the Congressional Budget Office to increase by 2.6 percent annually between 2000 and 2040. Some observers say that sustained economic growth could keep these increased expenditures at the same share of total GDP; others argue that current federal expenditure trends will become unsustainable without large tax increases. The potential of the employer-sponsored group LTC market to stave off a national LTC financing crisis has recently started to receive popular notice in the news media. However, for the potential of the group LTC market to be realized, there must be widespread employer sponsorship of group LTC plans and significant participation levels among eligible employees in these plans. The present analysis of industry data estimates the LTC plan sponsorship rate for all U.S. employers with 10 or more employees at 0.2 percent. The sponsorship rate among large employers is significantly higher (8.7 percent). The greatest growth opportunities are projected to lie in the smaller employer market, because it is enormous and virtually untapped. Nonsponsors cite a variety of barriers to employer sponsorship of LTC plans. For many nonsponsors, the most important obstacles are the intrinsic characteristics of their work forces: employees are too young, transient, part-time, and/or low-income to be suitable for LTC insurance. For many others, lack of awareness and low priority are the primary obstacles. Because group LTC insurance has been widely available for only 10 years, many benefits managers view it as "too new and untested." Prior to the passage of the Health Insurance Portability and Accountability Act (HIPAA), in August 1996, the tax treatment of long-term care insurance premiums was unclear because Congress had not addressed the issue and the Internal Revenue Service had not issued clear guidance. In essence, HIPAA served to clarify the tax status of LTC insurance and establish product criteria for tax qualification. The interventions contained in HIPAA appear to have been insufficient to stimulate coverage growth rates that will meaningfully reduced the future burden on government financing of LTC. Although employment-based LTC insurance appears to be the best mechanism for mass expansion of coverage at affordable rates, the data suggest that employer sponsorship of LTC plans is relatively rare, especially among smaller employers, and that sponsorship rates may not dramatically increase without significant investments in employer education and new incentives.

Adult↗
PubMed2000

Sources of health insurance and characteristics of the uninsured: analysis of the March 1999 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 1999 Current Population Survey (CPS), it represents 1998 data--the most recent data available. In 1998, 194.7 million nonelderly Americans--81.6 percent--had some form of health insurance. More than 64 percent had it through an employment-based health plan; 6.5 percent purchased it on their own; and 14.3 percent were covered by a public program, mostly through Medicaid (10.4 percent). In 1998, 18.4 percent of the nonelderly population was uninsured (43.9 million people), compared with 14.8 percent in 1987. The percentage of uninsured Americans has generally been increasing since at least 1987, although the percentage uninsured in 1998 was not statistically different from the percentage uninsured in 1997 (18.3 percent). The increase in the uninsured prior to 1993 can be attributed to the erosion of employment-based health insurance. However, since 1993, the percentage of nonelderly Americans covered by an employment-based health plan has increased from 63.5 percent to 64.9 percent. The decline in public sources of health insurance would mostly explain the recent increase in the uninsured. For example, between 1994 and 1998 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1993 and 1998, the percentage of nonelderly Americans covered by Medicaid declined from 12.7 percent to 10.4 percent as people left welfare. The increase in employment-based coverage since 1994 was due mainly to a higher likelihood that children were covered by an employment-based health plan. Between 1994 and 1998, the percentage of children covered by an employment-based health plan increased from 58.1 percent to 60.2 percent. For adults, it increased less than one percentage point, from 66.1 percent to 66.9 percent. Adults started to realize gains in employment-based health insurance between 1997 and 1998. Between 1994 and 1997, the percentage of working adults with employment-based health insurance coverage held steady at roughly 72.3 percent. During this period, health care cost inflation was essentially nonexistent. However, between 1997 and 1998, the percentage of working adults with employment-based health insurance increased from 72.2 percent to 72.8 percent, despite the apparent return of health care cost inflation in 1998. It is likely that the changing composition of the labor force accounted for some of the increase in employment-based coverage.

Adolescent↗
PubMed2000

Comparing the medical expenses of children with Medicaid and commercial insurance in an HMO.

BACKGROUND: In recent years, growing numbers of children with Medicaid have been enrolled in managed care plans nationwide. Yet, large, commercial managed care plans are increasingly discontinuing their participation in Medicaid because of low Medicaid payment rates. OBJECTIVE: To compare the healthcare utilization and costs of children with Medicaid and children with commercial insurance within the same health maintenance organization (HMO). STUDY DESIGN: Retrospective study using electronically captured cost and utilization data. PATIENTS AND METHODS: We compared the healthcare utilization and costs of children with Medicaid (n = 42,636) and children with commercial insurance (n = 159,651) who were members of the same large, nonprofit HMO at any time between January 1, 1995, and December 31, 1997. Medicaid children were grouped as income eligible, medically needy, and blind or disabled. RESULTS: The unadjusted costs of income-eligible, Medicaid-insured children were not significantly different from those of commercially insured children. The medically needy were $25 per month more expensive than commercially insured children (P = 0.02), and the blind or disabled were $213 per month more expensive (P < .01). After adjusting for age and sex, income-eligible children were $5 per month more expensive than children with commercial insurance (P = .07), the medically needy were $20 per month more expensive (P = .02), and the blind or disabled were $216 per month more expensive (P < .01). CONCLUSIONS: The costs of income-eligible, Medicaid-insured children in this HMO were similar to those of commercially insured children, but the costs for the medically needy and the blind and disabled were substantially higher.

Adolescent↗
PubMed2002

Citizens' views on health insurance in Croatia.

AIM: To examine the citizens' attitudes toward health insurance and its reform in Croatia, and their views on private payments for health care services. METHOD: In 1999 and 2000, we surveyed 500 randomly selected adults from all regions of Croatia, aged 40 years and over. The questionnaire included questions on social health insurance, private payments for health care, and background information. The net response was 393 (79%). The analysis of the data collected included univariate and multivariate analyses to test the differences in the attitudes among sociodemographic and socioeconomic groups. RESULTS: Most interviewed Croatian citizens (83.2%) expressed the opinion that everybody should have access to health care services, irrespective of the health insurance contributions. However, 32.1% agreed that the utilization of services should depend on the payment of contribution; 39.1% believed that the money they contributed to health insurance corresponded to health care services they received; 60.1% agreed that insurance rate should increase proportionally to income. When asked about reforms, more than half (53.4%) thought that the current health insurance covered less benefits than 10 years earlier, whereas more than a third believed that changes offered more choice (36.9%) but less equity (37.7%), and 46% disagreed with the introduction of the basic package of health care benefits and supplementary insurance. About the same percentage of respondents thought that they had already been paying too much for health care out of their own pockets. CONCLUSION: Citizens in Croatia do not hold a positive opinion on health insurance reform. They fear the changes would bring about limitations in their social rights and increase their financial burden.

Adult↗
PubMed2002

Lack of an association between medicare supplemental insurance and delay in seeking emergency care for patients with myocardial infarction.

STUDY OBJECTIVE: Previous studies have shown that Medicare patients without supplemental insurance are less likely to receive preventive services, such as mammography. The effect of supplemental insurance on the appropriate use of emergency services is unknown. We sought to determine whether the absence of supplemental Medicare coverage is associated with increased delay in seeking care for acute myocardial infarction. METHODS: In this retrospective cohort study, we compared the time from symptom onset to hospital arrival (the time-delay interval) in Medicare patients with and without supplemental insurance coverage who presented with an acute myocardial infarction to 1 of 19 hospitals in King County, WA, from 1989 to 1993. There were 1,373 patients with Medicare-only coverage and 2,050 patients with Medicare plus supplemental insurance coverage. RESULTS: The age-, sex-, and race-adjusted median time delay was 135 minutes for the Medicare-only group and 130 minutes for the Medicare plus supplemental insurance group (P =.34; 95% confidence interval for median time-delay difference in minutes -5 to 10). There was no significant association between the presence of Medicare supplemental insurance coverage and time delay in Cox regression models, which also adjusted for event year, income, education, past cardiac history, and clinical symptoms. CONCLUSION: For this cohort of Medicare patients, the absence of supplemental insurance coverage did not lead to significantly increased delays in seeking care for myocardial infarction. Lack of supplemental insurance for Medicare patients might not have as great an effect on the use of emergency services as it has on other health care services.

Aged↗
PubMedDate not supplied

[Change in the income status of the disabled after introduction of long-term care insurance].

Up to the present time, long-term-care needs in the Federal Republic of Germany have only been covered to a limited extent through health insurance. The needs of the majority of those requiring long-term care must be covered from their pension funds or acquired wealth. This often does not suffice, which results in those needing long-term care becoming recipients of social assistance. The introduction of a long-term-care insurance should bring an end to this situation, which is considered unacceptable. At present, two competing schemes for covering the social risk of long-term care are being discussed: a social security insurance and a private insurance. When comparing the planned benefits under consideration, the social security insurance is more favorable in regards to nursing-home treatment, as well as with at-home care and benefits in kind. The private insurance is more favorable when considering nursing-home treatment and monetary benefits. If the private insurance is adopted, over 31% of those formerly relying on nursing-home care would no longer need social assistance. In the case of social security insurance, almost 46% would no longer require social assistance. Most of the remaining individuals requiring social assistance would be women.

Aged↗
PubMed2003

[Changes in community health and welfare services with introduction of the long-term care insurance system in Japan].

OBJECTIVE: In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services. METHODS: We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses. RESULTS: A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system. DISCUSSION: Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.

Aged↗
PubMed2003

The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?

BACKGROUND: Elimination of racial and ethnic disparities in health has become a major national goal. The State Children's Health Insurance Program (SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. OBJECTIVE: To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. SETTING: SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. DESIGN: Telephone interview (mailed survey in Alabama) about the child's health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. SAMPLE: New SCHIP enrollees (0-17.9 years old in Alabama, Kansas, and New York and 11.5-17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. MEASURES: Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any race]), prior health insurance, health care access and utilization, and health status. ANALYSES: Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. RESULTS: Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single-parent and lower-income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. CONCLUSIONS: SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. IMPLICATIONS FOR MONITORING AND IMPROVING SCHIP: SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program's impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.

Adolescent↗
PubMed2004

Relationships between treated hypertension and subsequent mortality in an insured population.

OBJECTIVE: To investigate if a mortality differential exists between insurance policyholders with treated hypertension and policyholders who are not under such treatment, where both groups are noted to have the same blood pressure at the time of policy issue. BACKGROUND: Hypertension is a known mortality risk factor in the insured and general population. Treatment for hypertension is very common in the insured population, especially as age increases. At the time of insurance application, a subset of individuals with treated hypertension will have blood pressures that are effectively controlled and are in the normal range. These individuals often meet established preferred underwriting criteria for blood pressure. In some life insurance companies, they may be offered insurance at the same rates as individuals who are not hypertensive with the same blood pressure. Such companies make the assumption that the pharmacologically induced normotensive state confers no excess risk relative to the natural normotensive state. Given the potential pricing implications of this decision, we undertook an investigation to test this hypothesis. METHODS: We studied internal data on direct and reinsurance business between 1975 and 2001 followed through anniversaries in 2002 or prior termination with an average duration of 5.2 years per policy. Actual-to-expected analyses and Cox proportional hazards models were used to assess if a mortality differential existed between policyholders coded for hypertension and policyholders with the same blood pressure that were not coded as hypertensive. RESULTS: Eight thousand six hundred forty-seven deaths were observed during follow-up in the standard or preferred policy cohort. Within the same blood pressure category, mortality was higher in policyholders identified as treated hypertensives compared with those in the subset of individuals who were not coded for hypertension. This finding was present in males and females and persisted across age groups in almost all age-gender-smoking status subsets examined. The differential in mortality was 125% to 160% of standard mortality based on the ratio of actual-to-expected claims. CONCLUSION: In this insured cohort, a designation of treated hypertension is associated with increased relative mortality compared to life insurance policyholders not so coded.

Actuarial Analysis↗
PubMed1991

Differences in hospital resource allocation among sick newborns according to insurance coverage.

OBJECTIVE: To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services. DESIGN: Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition. SETTING: All California civilian acute-care hospitals. PATIENTS: Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751). MAIN OUTCOME MEASURES: Length of stay, total charges, and charges per day. RESULTS: Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured. CONCLUSIONS: The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.

California↗
PubMed1990

Organ transplantation costs, insurance coverage, and reimbursement.

With few exceptions, most organ transplantation procedures are expensive, although there is considerable variability in costs across transplantation programs. Because of their high cost, many public and private insurers are in the process of carefully evaluating their transplantation coverage and reimbursement policies. Some public insurers have decided to discontinue paying for some procedures on grounds that the resources expended on transplantation could be used to benefit a larger number of people without catastrophic disease. Thus, transplantation is being pitted against health promotion and disease prevention initiatives. Some insurers have also been reluctant to pay for selected transplants, arguing that they are "experimental" or "investigational." Pancreas, lung, and heart-lung transplants are often classified as such. While these decisions have a reasonable basis, concerns related purely to cost, not benefit, have made insurers hesitant to extend coverage to procedures they view as inefficacious. Transplantation programs performing pancreas, heart-lung, and lung transplantation, therefore, do so at some risk. They may not be reimbursed for the procedures they perform, or, more likely, the level of payment received is likely to be substantially below actual hospital costs. To control costs, insurers have also begun to designate transplantation centers. In doing so they limit coverage and reimbursement to programs they regard as "centers of excellence." To become a designated center, a transplantation program must meet preestablished volume and outcome requirements, which insurers believe will assure quality and minimize costs. Thus, designated centers are expected to provide cost-effective transplantation services. If insurers choose to regionalize transplantation programs, controlling both their number and distribution, it is quite possible that patient access to transplantation, as well as their choice of provider, will be severely constrained. In conclusion, concerns related to transplantation costs undoubtedly will have enormous implications for the delivery of transplantation services throughout the foreseeable future. Most significantly, the number of "qualified" centers, using insurer criteria, may be restricted to a small subset of currently active programs. This could have a dramatic affect on the start-up of new programs and the continuation of others.

Costs and Cost Analysis↗
PubMed1989

Medical insurance and childhood general practitioner contacts.

The relationships between the duration of medical insurance coverage and rates of general practitioner consultations for morbidity were examined for a birth cohort of children studied to ten years. This showed that children from insured families had higher consultation rates even when due allowance was made for known social and economic factors correlated with the ownership of insurance. During the period from birth to five years children who were insured throughout the period made a mean of 19.16 consultations compared to 15.38 for the uninsured (p less than 0.001); during the period from five to ten years the insured made 13.07 contacts compared to 9.38 for the uninsured (p less than 0.001). The net effects of these trends were that children whose families had been insured throughout the ten year study period made a mean of nine more general practitioner consultations by the age of ten years than children from uninsured families. It is concluded that the presence of private medical insurance encourages the development of inequalities in childhood access to health care with children from insured families having greater access to care than children from uninsured families.

Child↗
PubMed1989

[The significance of "coronary risk" for life insurance].

In many countries heart and circulatory diseases are still the commonest cause of death (over 50%). This is particularly important for the life insurer because heart and circulatory diseases, including coronary heart disease, represent a relatively important risk in life insurance and that is often difficult to insure against. With the help of some diagrams (from the literature), an attempt is made, firstly to demonstrate the epidemiological relationships between "risk factors" and coronary heart disease, and, secondly, to show the relationship between the extent and localisation of arteriosclerosis in the coronary vessels and its influence on mortality, which is decisive for the life insurer. In the last three decades, new and more favourable factors for the insurability of coronary heart disease have come into existence. This circumstance is being and has been increasingly taken into account in risk assessment for life insurance. To the degree that the significance of the coronary heart disease risk for the life insurer has decreased, the acceptance of coronary risks has increased. There are three factors, above all, that determine the insurability of coronary heart disease: a) the age of the insuree; b) the presence of "cardiac risk factors"; c) the state of the coronary vessels of the insuree (existence of corresponding clinical findings).

Coronary Disease↗
PubMed1989

Health insurance status of young adults in the United States.

Sociodemographic and health characteristics of young adults who are uninsured, publicly insured, and privately insured were examined using the 1984 National Health Interview Survey. The results indicated that 26% of 19 to 24-year-old persons had no health insurance protection, 65% were privately insured, 7% were publicly insured, and 1% had both private and public coverage. Young adults at greatest risk for being uninsured were male, Hispanic and black, poor and near-poor, unemployed, high school dropouts, living with others, and residing in the South and West. All young adults predictably lose or change health insurance as they move from dependence to independence. It was concluded that greater use of new and existing transitional insurance options should be offered as well as targeted educational and communication strategies to assure that all young persons enter adulthood with some basic insurance protection.

Adult↗
PubMed1988

[Principles of risk assessment in the life insurance industry as exemplified by ulcerative colitis].

This report addresses physicians whose work lies outside the field of life insurance and especially its particular type of risk assessment. It attempts to clear up some typical misconceptions arising between attending physicians and the medical consultant working in life insurance. Taking as an example the life insurance application of a man with conservatively treated ulcerative colitis, risk assessment procedure from the viewpoint of life insurance is analyzed on the basis of the Swiss Reinsurance Company rating guidelines. Attention is drawn to the specific features of prognosis assessment in life insurance compared with that in medical practice or at the bedside. The concepts of mortality and extra mortality are defined and that of mortality compared with the concept of survival rate. The example of the colitis patient is used to show why the extra mortality observed by life insurers can be markedly above that indicated by epidemiologists and clinicians, and why a practically normal 5-year survival rate and significantly increased mortality need not be mutually exclusive. The statistical basis for the mortality assumptions of life insurers is exemplified by the Medical Impairment Study 1983 published in autumn 1987, which gives an average extra mortality of 162% for insured persons who had ulcerative colitis at the time of policy issue.

Adult↗
PubMedDate not supplied

Are subsidies enough to encourage the uninsured to purchase health insurance? An analysis of underlying behavior.

A growing concern over gaps in health insurance coverage has led to proposals for reform. Some proposals rely on incentives to encourage the purchase of private health insurance, while others rely on mandatory purchase. This paper explores families' demand for private health insurance, with an emphasis on lower income families, in order to understand the factors that affect purchasing decisions. The study uses data from the 1977 National Medical Care Expenditure Survey to show which factors are important in determining whether or not families purchase private health insurance as well as the quantity of insurance purchased. Results indicate that it is the combination of income, price, and substitutes for private health insurance that impact families' decision to purchase private health insurance. As long as a safety net of substitutes exists for low-income families, subsidies may not be enough to encourage more extensive private health insurance coverage.

Costs and Cost Analysis↗
PubMed1999

The effect of the 30% private health insurance rebate on the purchasing behaviour and intentions of the Australian population.

This article examines the likely effect of the 30% private health insurance rebate on private health insurance coverage. It is based on a survey of the Australia population conducted in April-May 1999 which collected information on health insurance purchasing behaviour and intentions. These data are used to predict the subsidy's likely effect on hospital insurance coverage, with estimates ranging from 30.5% to 34.3% by May 2000. Ancillary insurance membership is forecast to increase to between 32.7% and 37.2% of the population over the same period. The 30% insurance rebate will probably produce, at best, a small increase in hospital insurance membership. The cost of the rebate is estimated at $1.4 billion in 1999-2000. Given the small increases in projected membership, the cost of the initiative is very high.

Age Factors↗
PubMedDate not supplied

The nongroup health insurance market: short on facts, long on opinions and policy disputes.

Individual health insurance is more administratively costly and more prone to adverse selection (especially in the presence of community rating) than group health coverage is. In this paper we show that the individual market has been shrinking over time but that it might be stimulated if tax credits for such insurance were made available. The primary areas of factual disagreement have to do with the frequency with which individual insurers charge some applicants higher premiums than others (based on health risk), and the effect that premiums related to risk have on the likelihood of insurance purchase at different income levels. The primary area of policy disagreement concerns the value of offering insurance at lower premiums to higher risks relative to the value of making voluntary insurance attractive to lower risks. We argue that a major market failure for individual coverage may be caused by insurers' inability to distinguish some truly low risks. We conclude that the individual market works acceptably well for about 80 percent of potential buyers, but its performance for the remaining 20 percent of low-income or high-risk persons is controversial.

Adolescent↗